EARLY BIRD REGISTRATION NOW EXTENDED UNTIL JUNE 11, 2024
About This Event
Join us for an exciting in-person Dance Workshop held at Marymount Manhattan College! Our NYC Summer Workshop 2024 is a must-attend for intermediate/advanced dance enthusiasts. You'll experience days filled with technique classes, seminars, & more! Get ready to immerse yourself in a world of movement, creativity, and fun. Whether you're an intermediate or advanced dancer, our workshop offers a unique opportunity to learn from talented instructors and connect with fellow dance lovers. Don't miss out on this incredible experience to expand your skills, ignite your passion for dance, and build community. Mark your calendars and get ready to EMERGE as a better artist!
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Registration
Complete form below to signup for the workshop.
Name
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First Name
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Birthday
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Age
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Phone Number
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Address
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Street Address
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Year
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Emergency Contact Name
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Emergency Contact Phone
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Emergency Contact Email
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Do you give permission for EMERGE125 to obtain immediate medical treatment on your behalf in case of emergency?
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Known Medical Conditions
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Known Allergies (Including Food)
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Medications taken on a regular schedule
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Do you have Medical Insurance? (If yes, please provide the name, policy holder, insurance policy #, and group #)
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I hereby authorize EMERGE 125 INC. d/b/a EMERGE125 and its employees and representatives (“E125”) to consent to emergency medical care on my behalf including diagnostic imaging, imaging, examination, anesthetic, dental, medical or surgical treatments
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Yes
No
Minors Only - Parent/Guardian Name
Minors Only - Parent/Guardian Relationship to Participant
Minors Only - Parent/Guardian Phone
Minors Only - Parent/Guardian Email
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Release Forms
Photo/Video Release
I understand and agree that: All rights of every kind in and to all image and/or sound recordings made of me by EMERGE125 ("E125") or any Indemnitee (the “Footage”) shall be and remain the sole and exclusive property of E125. Such rights shall include, without limitation, the perpetual and irrevocable right to use and re-use said Footage in connection with promotional materials, grant proposals and social media or otherwise advertising, publicizing, exhibiting, merchandising, distributing and exploiting the Footage in any manner whatsoever and at any time by all means, media, devices, processes and technology now or hereafter known or devised in perpetuity throughout the universe. Neither me nor any other party now or hereafter claiming an interest in the Footage shall have any right of action against E125, any Indemnitee or any other party arising from or based upon any use or exploitation of such Footage, unless such use is defamatory, untrue or censurable in nature. E125 shall not be obligated to make any actual use of any Footage.I am aware that this is a full release of liability and a binding contract between myself and E125, and I sign it of my own freewill.
Signature
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Liability Release
I understand and agree that: This release is intended to discharge in advance EMERGE125 (“E125”) and each of its officers, directors, employees, representatives and agents (each, an “Indemnitee”) from and against any liabilities, losses, claims, demands, costs (including, without limitation, attorneys’ fees) and expenses, except for those resulting solely from the gross negligence or willful misconduct of such Indemnitee (collectively, “Liabilities”) arising out of or in connection with my participation in any activity organized or sponsored by E125 (the “Activities”).The Activities I will participate in may be hazardous, strenuous and/or physical in nature. Participation in the Activities may result in serious injury to myself or others or costly damage to property belonging to me, to E125 or to others. Knowing the risks involved, I nevertheless voluntarily consent to participate in the Activities.I hereby assume any and all risks of injury, death or property damage and release E125 and each Indemnitee from any and all Liabilities arising out of or in connection with my participation in the Activities, for which I acknowledge that neither E125 nor the Indemnitees will have any responsibility.I will indemnify and hold harmless E125 and each Indemnitee from any and all Liabilities arising out of or in connection with my participation in the Activities, including Liabilities relating to any injury and/or property damage, which I or anyone else (including E125 and the Indemnitees) may sustain while I am participating in the Activities.All rights of every kind in and to all image and/or sound recordings made of me by E125 or any Indemnitee (the “Footage”) shall be and remain the sole and exclusive property of E125. Such rights shall include, without limitation, the perpetual and irrevocable right to use and re-use said Footage in connection with promotional materials, grant proposals and social media or otherwise advertising, publicizing, exhibiting, merchandising, distributing and exploiting the Footage in any manner whatsoever and at any time by all means, media, devices, processes and technology now or hereafter known or devised in perpetuity throughout the universe. Neither me nor any other party now or hereafter claiming an interest in the Footage shall have any right of action against E125, any Indemnitee or any other party arising from or based upon any use or exploitation of such Footage, unless such use is defamatory, untrue or censurable in nature. E125 shall not be obligated to make any actual use of any Footage.I am aware that this is a full release of liability and a binding contract between myself and E125, and I sign it of my own free will.
Signature
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Medical Release
I hereby authorize EMERGE125 and its employees and representatives (“E125”) to consent to emergency medical care on my behalf including diagnostic imaging, imaging, examination, anesthetic, dental, medical or surgical treatments, transfusion, emergency transportation and hospital care, under the general supervision or advice of a licensed physician, surgeon or dentist. I understand this authority is given in advance of any specific diagnosis, treatment or hospital care being recommended but is given to provide authority and power to E125 to give specific consent to any and all diagnosis, treatment or care, which the physician, surgeon or dentist, in the exercise of his/her judgment, may deem advisable. It is also understood that all reasonable efforts will be made to contact the emergency contact listed above before medical testing, treatment or care is administered. This authorization is for emergency cases only, as determined by E125 or, if available, by the supervising physician, surgeon or dentist.
Signature
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Minor Release
PARENT / GUARDIAN WAIVER FOR MINORS (Only if student is under 18 years old) The undersigned parent and natural guardian does hereby represent that he/she is, in fact, acting in such capacity, has consented to his/her child or ward’s participation in the activity or event, and has agreed individually and on behalf of the child or ward, to the terms of the accident waiver and release of liability set forth above. The undersigned parent or guardian further agrees to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor, the parents, of the legal guardian.The undersigned parent and natural guardian does hereby represent that he/she is, in fact, acting in such capacity, has consented to his/her child or ward’s participation in the activity or event, and has agreed individually and on behalf of the child or ward, to the terms of the accident waiver and release of liability set forth above. The undersigned parent or guardian further agrees to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor, the parents, of the legal guardian.The undersigned parent and natural guardian does hereby represent that he/she is, in fact, acting in such capacity, has consented to his/her child or ward’s participation in the activity or event, and has agreed individually and on behalf of the child or ward, to the terms of the accident waiver and release of liability set forth above. The undersigned parent or guardian further agrees to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor, the parents, of the legal guardian.> The undersigned parent and natural guardian does hereby represent that he/she is, in fact, acting in such capacity, has consented to his/her child or ward’s participation in the activity or event, and has agreed individually and on behalf of the child or ward, to the terms of the accident waiver and release of liability set forth above. The undersigned parent or guardian further agrees to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor, the parents, of the legal guardian.
Signature
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Workshop Registration Ticket (2-day):
Early bird price until June 11, 2024
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145.00
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Workshop Registration Ticket (single day)
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115.00
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